Protecting, maintaining and improving the health of all Minnesotans

September 2, 2009

Dear Athletic Director or Coach:

We are writing to you regarding recommendations for coaches and athletic directors to reduce the spread of influenza on athletic teams.  Because of the amount of time, close proximity, and sharing of personal items that often occurs in sports, there may be increased risk of influenza spread in sports teams.  Also, most of the people who had novel H1N1 influenza in Minnesota have been school-aged children.

We may have more influenza cases this year than usual.  In addition to the “seasonal” influenza that occurs every fall, we are likely to see cases of the novel H1N1 influenza (“swine flu”) that first appeared last spring. Novel H1N1 influenza never completely went away over the summer, so the influenza season may start early this year.

Novel H1N1 influenza seems to be acting like seasonal influenza in terms of how sick it makes people and how it is spread. Most people who have had novel H1N1 influenza in Minnesota have recovered without complications. However, like any influenza virus, novel H1N1 can be a serious disease.  Some people have been hospitalized with novel H1N1, and several deaths have occurred from it. 

Influenza primarily spreads when a person with the flu coughs or sneezes. You can help prevent the spread of influenza by taking the steps that follow.  These steps are intended to reduce influenza spread such that schools and school-based activities are able to maintain normal functioning and stay open.         

  1. Athletes should not participate in activities if they have symptoms of influenza. That means a fever of 100 degrees Fahrenheit or greater, with cough and/or a sore throat.  Other symptoms of the flu include runny nose, headache, body aches, vomiting and diarrhea (in addition to fever and cough or sore throat).  If you identify an athlete who has flu symptoms, immediately exclude them from participation in practice or games, and follow your usual procedures for sending them home.    


  1. Sick athletes should stay home and not participate in activities for at least 24 hours after their fever is gone without use of fever-reducing drugs like Tylenol or Motrin. Usually that means staying home for 5 to 7 days. Athletes staying home with flu symptoms should avoid contact with others except to get medical care. Aspirin or aspirin-containing products should not be used when a child has influenza symptoms.  

Additional important points:

o    The exclusion period is the same even if someone is on antiviral drugs such as Tamiflu (oseltamivir) or have had a influenza test that is negative, these tests are not always accurate.

o    Even after they can participate in athletics, athletes will be able to spread influenza, although less easily than when they had fever. To avoid spreading the virus, it is very important that they clean their hands frequently, cover coughs and sneezes with a sleeve or tissue, and not share personal items (e.g., water bottles).


  1. Have athletes clean their hands often, with soap and water or an alcohol-based hand rub. They will need to use soap and water if their hands are visibly soiled.


  1. Encourage athletes to cover coughs and sneezes. They should use a tissue when one is available, but they can also cough or sneeze into an elbow or arm. Hands should not be used to cover a cough or sneeze.


  1. Make sure athletes do not share personal items. That includes items like water bottles, drinks, food or eating utensils.  Have athletes use disposable cups or ask them to bring personal water bottles. 


  1. Inform the school health professional if athletes develop symptoms of influenza.  This will assist the school health professional in monitoring influenza-like illness in the school and determining whether additional steps may be necessary to reduce influenza spread.


If novel H1N1 influenza begins causing more severe disease, recommendations may change. For example, students with flu symptoms may need to stay home longer and not participate in sports for up to seven days, regardless of when their fever goes away. Some schools may even need to close, for as long as seven days or more.

For more information, visit the Minnesota Department of Health website at or the federal flu website at

Thank you for your assistance in helping to reduce the spread of influenza. 


Ruth Lynfield, MD

State Epidemiologist

Infectious Disease Epidemiology, Prevention, and Control Division

Minnesota Department of Health